DESCRIPTION (Applicant's abstract): Assisted living (AL) is a rapidly growing type of residence for the elderly, with approximately 1.3 million seniors as residents, and with an expected two-fold increase in occupancy over the next 10-15 years. Preliminary data presented here suggest that the elderly in AL have high rates of psychiatric disorders, with dementia being the most common. These conditions probably contribute to significant morbidity (such as functional impairments and caregiver burden), and to early discharge from AL, typically to a nursing home. Dementia and other psychiatric disorders are probably under-recognized and under-treated in AL, in part because of inadequate preparation of the AL care system to address them. There has never been a comprehensive study of dementia or of other psychiatric disorders in AL This study will gather information about the prevalence, detection, and treatment of dementia and other psychiatric disorders in AL residents. It will study a stratified, random sample of 275 AL residents in Maryland (100 from large facilities, 100 from small facilities and 75 from dementia special care units). Each resident will undergo a comprehensive evaluation for dementia and a standardized psychiatric diagnostic examination. S/he will also be rated on standardized scales quantifying dementia-associated behavioral disturbances, seriousness of general medical co-morbidity, severity of functional (IADL and ADL) impairments and caregiver burden. This will produce an estimate of the prevalence and morbidity associated with dementia in AL residents (Aim 1). It will also generate an estimate of the prevalence and morbidity associated with other psychiatric disorders, especially mood and anxiety disorders (Aim 2). Patient evaluations, chart reviews and interviews with family and professional caregivers will determine whether dementia or other psychiatric disorders are detected, or treated and how this affects clinical outcomes in assisted living (Aim 3). Study findings will likely have a substantial public health impact in gerontology, geriatric medicine and geriatric psychiatry. They will provide essential information about the prevalence and consequences of psychiatric morbidity among assisted living residents (projected to approach 3.9 million by 2025). This information is of great interest to healthcare providers, licensing agencies, policy makers, the assisted living industry and the general public. It is likely to affect clinical practices in assisted living resulting in the implementation of assisted living-based screening and treatment programs for dementia and other psychiatric disorders that will benefit residents, and may delay their discharge from assisted living facilities to nursing homes.